Timothy Mayleben
Analyst · WBB Securities
Yes, Steve. So a little bit of background on CLI. So today, the -- let me just maybe make a couple of comments on the numbers here. So it's estimated that there are somewhere between 10 million and 12 million patients in the U.S. with what's called PAD, or peripheral arterial disease. Of those, it's estimated, again, about 10% or 1 million to 1.2 million of those patients have CLI and then taking one step down further, there are about 1/3 of those or about 400,000 patients that have what's called no-option CLI. And no-option CLI, or what we term as the most severe form of PAD, these patients are no longer candidates for interventional procedures. And again, the standard of care today for most CLI patients is some form of starting with endovascular procedures so atherectomies, balloon angioplasties, many of the same interventions that are done in the heart are done in the legs to try -- and the whole goal of these procedures is to open up blood flow to the lower extremities. Try to restore blood flow to ischemic tissues, which as you know, ischemic tissue is not profused, it doesn't get blood flow. So the standard of care, as we understand it today, is interventional procedures. When the endovascular procedures are no longer working, then the patient's progress to bypass, open bypass, which again, the strategy there is, again, to re-vascularize these patients. Take a vein from another part of the body and try to use it to restore blood flow to the lower extremity. When those fail, the physicians really don't have a whole lot left in the armamentarium, the treatment armamentarium. There is, of course, wound care management which, again, for anybody who has looked at this, there is the goops and gauzes, as the phrases goes, there's negative pressure wound therapy. A number of devices and efforts, technologies, to try to manage the wounds. I think as Dr. Hyatt, who was on a conference call last June with us said, if you can manage the wounds then you can typically manage the CLI disease. But these wounds, these open wounds that form on the legs of these patients -- and the feet of these patients are very, very difficult to manage. So once they progress to open wounds, it's very difficult to manage those wounds, and 25% of these patients are going to end up dying within a year, 25% are going to end up with an amputation. So we call it, and I think the industry calls it, a no-option CLI patient population because none of the options are very good and amputation is not good, obviously, death is not good, and the palliative care that is available is not very helpful at this point.